THE “LACK OF CLARITY OF THOUGHT” ARGUMENT

The basis of all opposition to euthanasia for the mentally ill in the field of medicine is the misguided assumption that the mentally ill who wish to be euthanized are “lacking in clarity of thought” needed to be able to make informed, rational decisions when they express wishes to be euthanized to end the recurrent, intolerable pain that they endure because of their mental illnesses. The world’s clinicians and world governments which forbid euthanasia to the mentally ill argue that it is never appropriate to euthanize the mentally ill because the state of emotional duress that they may be in when experiencing death wishes makes them “mentally incompetent” to make rational, informed decisions about their life. However, those of us who favor euthanasia for the mentally ill are not swayed by this argument. After all, we take into account the level of suffering of those who wish to be euthanized, rather than their mere “thinking ability.” Therefore, this leads us to question the following: 

  

Are the death wishes that an individual experiences from emotional suffering a justifiable reason to force that individual into compulsory treatment and intervention?  

  

Those who oppose euthanasia for the mentally ill would likely answer this question with a resounding “yes.” After all, they believe that an individual in that situation is “mentally handicapped” in their decision-making process, and they would claim that their condition is treatable- pointing at all the treatment methods that have been developed to date to treat mental health issues. Those of us who favor euthanasia for the mentally ill, however, have other considerations. For example, we take into account that there are many individuals who have a treatment-resistant mental illness, while also acknowledging that no treatment method available for mental illness is 100% effective for 100% of consumers. This leaves us with a significant population of individuals with mental illness who do not benefit from these treatment methods who therefore experience death wishes because they suffer from chronic and intolerable pain due to their unbearable struggle with mental illness, thus diminishing the validity of the argument against euthanasia that such conditions are “treatable.” This raises another important question: 

  

Can the experience of chronic and intolerable suffering of a mentally ill individual be a justification to favor euthanasia to end this suffering? 

  

Those who oppose to euthanasia for the mentally ill would likely answer this question with a resounding “no.” After all, they ultimately favor and prioritize life-preservation over pain-extinction, and therefore favor life-imposition over freedom of choice between life or death. Those of us who favor euthanasia for the mentally ill, however, find this agenda to be deeply troubling. At its core, it is life-centered rather than patient-centered. This mentality in turn neglects important aspects of the suffering that those with refractory mental illness experience and raises important concerns about current medical practices worldwide which deny euthanasia to the mentally ill, and the validity and ethics of the “lack of clarity of thought” argument as the standard pretext to encourage these practices.  

  

“Lack of Clarity of Thought”: Scientifically Sound Argument, or Gaslighting Strategy? 

  

In order to evaluate the validity of the “Lack of Clarity of Thought” argument against euthanasia for the mentally ill, we decided to use evidence against it, straight from the horse’s mouth, to see how that argument would hold out. To do this, we will use the testimony of an individual with refractory mental illness who wishes to be euthanized. They will use the name “Marie,” tell their story, and explain why they want to be euthanized.  

  

“My mental illness has made it extremely difficult for me to have a tolerable life, and for me to be able to advance through it smoothly. I struggle with developmental disorders that make me inept in social situations and make it hard for me to make friends or even land a committed relationship with someone. People think I’m stupid or that I’m creepy and petty, so they push me away without even thinking about it. I get rejected like this on a regular basis, and every instance of this rejection feels bad, especially when I see other people getting together as friends, or when I see two people holding hands, staring passionately at each other, and making out. My developmental disorders also make it hard for me to do well in high-demanding classes or jobs, which means that I’m prone to be stuck in low-end jobs as I have been for a decade after I was supposed to graduate from college. I’m 33 years old right now and I’m STILL dependent on my aging parents for financial support. I also struggle with a personality disorder, which makes me feel overly attached to people who (I think) show an ounce of interest in me, only for them to lose that interest when I cling to them. People push me away in those instances, and I cannot begin to tell you how much pain I feel when that happens. It’s a stabbing pain I would not wish for my worst enemy. This personality disorder makes it a painful struggle for me to tolerate being rejected as it makes it a painful struggle for me to tolerate being alone, thus making me very prone to becoming very emotionally dependent on the approval, acknowledgment, and support from people of interest, none of whom are interested in me, to begin with. I’ve taken it upon myself to get help for these issues by having gone to talk therapy and by having taken prescribed medications for well over a decade, and the issues I’m facing from my mental health issues persist. There are neither pills nor is there a cure for personality disorders like BPD or CPTSD-There is DBT, but the problem with it, first of all, is that it’s expensive and I simply can’t afford a single session with what little I earn. Psychologytoday.com is full of practitioners who don’t take insurance and whose session fees are exorbitant, and no facility in my city that offers DBT takes my Medicaid (or any insurance, for that matter). And even if I could afford DBT, it would take very hard work and months (if not years) to yield results. I’m having the exact same problem with my treatment of Developmental Trauma. All of this makes matters all the worse, considering that my pain-coping threshold has been far surpassed for years. Also, no skills that I’ve learned in therapy (like grounding, counting to fucking 10, deep breathing, etc.) have helped me to make the issues I get from my developmental and personality disorders be the least tolerable. Like this was not enough, I also struggle with bipolar disorder, which makes me feel like my skull is cracking open when I'm off my Latuda for too long, or like I’m in a suffocating daze when it’s kicking in, or like I have no energy to do anything at all and like my body is petrified by an overwhelming depression into an ocean of despair even when I’m on the pill while gaining enormous amounts of weight from it. And this begs the question- why can’t medication developers make medications so that they don’t cause all these problems? Why do they have to make shitty medications that supposedly treat mental illness but cause a bunch of other problems to your body?! 

 

Most of the serious problems I’m faced with right now come from some disfunction or distressful signal from my brain that causes me some kind of suffering that has the potential to ripple into more suffering if I don’t have the edge or the know-how to cope with these mental health issues in ways that don’t cause more problems in my life. Like I said before, I’ve gone to therapy and have taken medications for over a decade to resolve these issues, but those approaches to treatment haven’t really been enough to keep me from having serious problems that are related to the issues I’m seeking treatment for to begin with.  

 

All these things are a shit-ton of issues to deal with- the social ineptitude, the compulsive clinginess, the rejection and ostracism from mainstream society, the painful biochemical imbalances and the nauseating trial and error of medicating are all heavy layers of pain that have sat on a vulnerable psyche that lives in agony by not being able to hold their weight but having to do so anyway. 

 

That shit is just too much. And it has been way too fucking much for way too fucking long. So, I’m done. I want to be euthanized. And I know, that it would take a toll on my family if that were to happen. They’d fall into torment and despair, and they would struggle to come to terms with the fact that I’d be gone for good, and they would go through anger, sadness, and other painful emotions as they struggle to process my death. They would be angry that I left them, and they would be sad that all the good things that could have happened in my life never did. So yes, I acknowledge that it would have a negative impact on some people if I were to be euthanized. But what about me? And what about my dignity? This mental illness has caused me to experience more pain and suffering than I can cope with, and it’s been that way for years. I’ve been very disenfranchised by many people as it is because of my mental illness and the behavioral issues that surge from it for years, so why should any of those people have a say on whether or not I should live? Should I remain alive because other people think I should or because other people want me to despite the suffering I endure because of my mental illnesses? These people don't necessarily understand the suffering I'm going through, and they're not the ones having to deal with what I have to deal with! Living a life of torment that I do not want to live because other people want me to and because they only want to focus on the good in my life and diminish the bad that has made it so unbearable, does not sound like a very reasonable gamble to me. It does not sound very considerate of me or my dignity, and it is old-fashioned thinking altogether- like the times when a person had a career path, or a spouse chosen for them by their parents or someone of "higher" authority. This is the 21st century now- an age of self-determination! So, if I am to be alive, it should be because I want to and because I feel glad and comfortable in doing so.” 

 

Most clinicians would draw the conclusion that Marie, in this particular instance, is lacking in clarity of thought because she is expressing death wishes. However, it is an obvious fact that a person who is truly incapable of thinking clearly cannot put two and two together. They wouldn’t be able to make sense of complex situations or to explain them in the way that Marie does here. She does this with profound clarity of thought and clarity of understanding of her situation, her role in it, the roles of others, and she demonstrates a clear understanding of what she would need to do to recover and the roadblocks she has endured for this recovery to take place. She also has a clear understanding of the implications of her actions on other people. This instance of clarity of thought in the midst of profound psychological distress gives way to an often-overlooked fact in the treatment of mental illness: 

 

Not everyone with mental illness who expresses death wishes is lacking in clarity of thought.  

 

To assume that Marie is “lacking in clarity of thought” for expressing death wishes in the circumstances that she is in and to deny her a euthanasia procedure on those grounds denotes an inadequate understanding and poor insight into the issues at play in people with mental illness who express death wishes in general, often ignoring the fact that instense pain, rather than an inability to think clearly, is the driving force behind many instances where the mentally ill express death wishes. Furthermore, because the #1 priority of many anti-euthanasia clinicians and world governments is to preserve the lives of the mentally ill who wish to be euthanized (even if it is against their will), it is fair to say that their use of the “Lack of Clarity of Thought” argument to discourage the death wishes that someone with mental illness expresses (in instances where emotional pain is the cause of said wishes) is a gaslighting strategy to coax them (and sometimes coerce them) into living- especially when one considers the zealous nature of their life-preservationist agenda, which deems “life” the only valid choice for the death-wishing mentally ill individuals that they oppress. This, in turn, involves a variety of ethical issues, as listed below. 

 

Why is the “Lack of Clarity of Thought” Argument Against Euthanasia a Problem? 

• It fails to address one of the most common factors that cause many with mental illness to experience suicidal ideation and leanings towards euthanasia in the first place. Pain, rather than mere “inability to think clearly,” is at the forefront of their death wishes in some instances. The way that those with mental illness in these instances “think” doesn’t always influence their death wishes as do their coping/pain tolerance thresholds being surpassed in a given situation, and sometimes for prolonged periods of time. People with refractory mental illness sometimes become suicidal because they are in pain, not necessarily because they “cannot think clearly.” 
  

• It heavily discredits the ability of those with refractory mental illness who wish to be euthanized to make informed decisions. Many of these individuals have already done their part by seeing therapists and psychiatrists, picking up coping skills and medications along the way, and using every resource within their reach to achieve recovery, over a very long time span, before determining that none of these resources have been helpful to help them achieve a life where their life-long mental illnesses are manageable and tolerable. Therefore, many of those with refractory mental illness lean towards euthanasia because the treatments they chose to undergo in the past were not helpful, not because they’re incapable of making good decisions about how to deal with their mental health problems in the first place.

• It insults the intelligence and rationale of those with refractory mental illness who wish to be euthanized, implying that their urge to end their pain through death is always because of “faulty thinking” rather than a genuine struggle to live through pain-inducing circumstances. It has overall negative connotations on the intelligence and thinking capacity of the mentally ill who wish to be euthanized, practically deeming them to be "stupid," "crazy," or "insane" just because they want to end their life through euthanasia.

• It dehumanizes the mentally ill who wish to be euthanized and invalidates their plight, neglecting and ignoring the recurrent pain they endure which leads them to suicidal thought and deeming it practically “meaningless,” and “less important” than their own life being preserved, and therefore not a valid enough factor to legitimize euthanasia to end the intolerable suffering caused by their mental illness. It also implies that the life preservation agenda of mental health regimes worldwide is more important than the will of the individual in a situation when the pain in their lives is intolerable.
• It neglects those with mental illness whose conditions are treatment-resistant, leaving them out of options to end their intolerable pain and suffering and thus prolonging their suffering.

• It overlooks the relatively insightful understanding that many of those with refractory mental illness who wish to die may have about their mental illnesses, the myriad of ways in which these illnesses cause their suffering (usually for prolonged periods of time), and the plethora of issues that these illnesses pose in their lives as a whole to a point where euthanasia is the only reasonable means to end their suffering once and for all. Contrary to popular belief, those with refractory mental illness who wish to be euthanized are not necessarily as lacking in awareness of the consequences and implications of their actions as a baby who is eager to touch a red, hot burning coil on a stove top without knowing they will get burned. In fact, those with refractory mental illness can be just as capable of understanding the impact of their euthanasia on those around them in the same way they understand the impact of their illnesses on their own lives. 

 

Conclusion 

 

The “Lack of Clarity of Thought” Argument that clinicians and world governments use to deny euthanasia to the mentally ill is a tool for oppression that practically forces the mentally ill who wish to be euthanized into continuing to live in pain-inducing circumstances that they have already expressed to have a marked difficulty in coping with, and an inability to cope with further. This oppression from anti-euthanasia clinicians and world governments is always carried out under the misguided cookie-cutter assumption that people with a mental illness in these circumstances are always lacking in clarity of thought simply because they express death wishes. In reality, this isn’t always true, as illustrated with Marie’s story. Furthermore, the “Lack of Clarity of Thought” argument fails in that it places too much focus on the “thinking ability” of those with refractory mental illness who wish to be euthanized and neglects the intolerable pain which leads them to experience death wishes in the first place. It also discredits their thinking ability when making decisions about their situation with intolerable suffering, even in instances when they have already made the choice to get help in the face of mental and emotional duress. This argument also diminishes the validity of said duress as an understandable reason to justify the use of euthanasia to eliminate a life that is mired with this kind of suffering. This argument places the life of the individual in higher regard than their dignity and comfort and imposes the idea that this must be the right order of things and that any thought that deviates from this idea is scientifically and ethically incorrect. The "Lack of Clarity of Thought" argument, therefore, has a hindering effect on the euthanasia-wishing individuals that it oppresses because it dehumanizes them by placing their pain extinction as second order of business (thus exacerbating their pain in the long run), and by degrading their rationale in times of great distress- that is, in times when they need the most understanding, validation, and compassion.